Impacto do uso sistêmico de estatinas e de bisfosfonatos nos tecidos periodontais: revisão narrativa / Impact of the systemic use of statins and bisphosphonates in the periodontal tissues: narrative review

Introdução: A literatura tem apontado uma possível relação entre diversas condições sistêmicas e as doenças periodontais. Dentro das doenças sistêmicas que podem gerar o uso crônico de medicamentos, com potencial associação com as doenças periodontais, destacam-se a hipercolesterolemia e o uso de estatinas; e as doenças do metabolismo ósseo e o uso de bisfosfonatos. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura sobre o efeito das estatinas e dos bisfosfonatos nos parâmetros clínicos e radiográficos periodontais de indivíduos adultos. Resultados: Apenas estudos observacionais em humanos foram incluídos. Um estudo mostrou que, em pacientes que apresentam doença periodontal e usam estatina, houve 37% menos bolsas periodontais (profundidade de sondagem ≥4mm) quando comparadas aos que não utilizam a medicação, além de apresentarem menor índice de carga inflamatória e menor perda de inserção clínica. Em relação aos bisfosfonatos em indivíduos com doenças que envolvem o metabolismo ósseo, sugere-se que a utilização do fármaco tem obtido resultados positivos nos parâmetros periodontais, como menores sinais clínicos de inflamação gengival, menor profundidade de sondagem, menor perda de inserção clínica e maior nível de osso alveolar, quando comparados aos que nunca realizam essa terapia. Conclusão: Dessa forma, as estatinas e os bisfosfonatos apresentam efeitos promissores, em pacientes sob tratamento para suas respectivas condições sistêmicas, na melhoria dos parâmetros periodontais, porém é importante salientar que são necessários mais estudos sobre o assunto para melhor entender os reais efeitos a longo prazo do uso desses fármacos.(AU)

Introduction: The literature showed a possible relationship between several systemic conditions and periodontal diseases. Within the systemic diseases that can generate the chronic use of these drugs, potentially related with periodontal diseases, it may be cited the hypercholesterolemia and the use of statins; and bone metabolism diseases and the use of bisphosphonates. Objective: In this sense, the present study aimed to review the literature about the effect of statins and bisphosphonates in the periodontal parameters of adults individuals. Results: Only observational studies in humans were included. A study showed that, in patients with periodontal disease and users of statins, there 37% fewer periodontal pockets (probing depth ≥4mm) when compared to those who do not use the medication, as well as having a lower rate of inflammatory burden and less loss of clinical insertion. Regarding the bisphosphonates in individuals diagnosed with diseases involving bone metabolism, it was suggested that the use of the drug has obtained positive results in periodontal parameters, such as a greater absence of plaque, less clinical signs of gingival inflammation, less probing depth, lower level of clinical insertion and higher level of alveolar bone when compared to those who never undergo this therapy. Conclusion: Thus, statins and bisphosphonates have promising effects in patients under treatment for their respective systemic condition in improving periodontal parameters, but it is important to emphasize that further studies on the subject are needed to better understand the long-term effects of the use of these drugs.(AU)

Síndrome metabólico, metformina y hueso / Metabolic syndrome, metformin and bone

El síndrome metabólico se define como un trastorno heterogéneo y multifactorial con riesgo cardiovascular elevado. Actualmente se encuentra en franco crecimiento debido al sedentarismo y la ingesta rica en grasas y azúcares. Su tratamiento incluye la indicación de cambios en el estilo de vida, con realización de actividad física y una alimentación saludable e hipocalórica. Cuando esto no es eficaz, se pueden utilizar diferentes fármacos, y entre los más prescriptos se encuentra la metformina, caracterizada por su acción insulino-sensibilizante. Numerosos trabajos han estudiado la vinculación del síndrome metabólico con el tejido óseo. Se demostró como resultado general, aunque no concluyente, que dicho síndrome se asocia con una disminución de la densidad mineral ósea y un aumento en la incidencia de fracturas osteoporóticas. Una de las limitaciones de estos estudios clínicos estaría ligada a la gran heterogeneidad de los pacientes con síndrome metabólico. Por otra parte, y dado que diversos estudios preclínicos han sugerido posibles acciones osteogénicas de la metformina, se ha investigado el posible efecto óseo de un tratamiento con este fármaco en personas con hiperglucemia o disglucemia. Varios estudios clínicos muestran que este efecto sería nulo o, en algunos casos, de carácter protector para el sistema óseo. No obstante, se debería tener precaución en el uso de dicho fármaco en pacientes que necesiten dosis altas y/o posean riesgo elevado de fractura, ya que sus altas concentraciones podrían tener consecuencias negativas sobre el metabolismo óseo. (AU)

Metabolic syndrome is defined as a heterogeneous and multifactorial disorder with high cardiovascular risk. Its incidence is currently growing due to sedentary lifestyles and diets with a high intake of fats and sugars. Treatment for metabolic syndrome begins with changes in lifestyle, such as physical activity and a healthy and hypocaloric diet. When this is not effective, different drugs can be used, and one of the most frequently prescribed is the insulin-sensitizer metformin. Numerous investigations have evaluated the possible link between metabolic syndrome and alterations in bone metabolism. Although not conclusive, most clinical studies point to an association between metabolic syndrome, a decrease in bone mineral density and an increase in the incidence of osteoporotic fractures. However, an important limitation of these studies is the great heterogeneity of individuals with metabolic syndrome. In view of preclinical research indicating possible osteogenic actions of metformin, the effects on bone of metformin has been evaluated in patients with hyperglycemia. Most studies have found either no effect on fracture incidence, or a mild protective action. However, since elevated concentrations of metformin might negatively affect bone metabolism, caution should be taken when prescribing this drug for patients who require high doses, and/or have an excess fracture risk. (AU)

Effect of alendronate on healing of bone defect and gingival tissue in osteopenic rats / Efecto del alendronato en la reparación de defectos óseos y tejido gingival en ratas con osteopenia

The aim was to evaluate bone repair and gingival tissue repair in osteopenic rats. Fifteen female wistar rats were included; in all of them ovariectomy was realized to induce osteopenia; after 45 days, the animals were submitted to 2 surgical techinques 1) dental extraction of the upper central incisor with no socket preservation and 2) 5 mm cranial defect in the calvarium; 5 rats were included in the control group (G1) withput alendronate application; in the group 2 (G2) was used subcutenous alendronate (0.5 mg/kg) once for three weeks and then was realizd the both surgical techniques. In group 3 (G3), after ovariectomy was realized the both dental extraction and the calvarium defect and after that was realized the alendronate protocol. In each group, after six week was realized euthanasia and descriptive histological analysis of the surgical areas involved. In bone formation of the 5 mm cranial defect was observed with good progression in the 3 experimental models and no modification in quality of bone repair was observed. For the gingival tissue in the extraction socket, no differences were observed between G1 and G3. On other hand, in G2 a thinner and reduced gingival epithelium was found. Our results showed that alendronate was not an obstacle for bone repair; deficiencies in re-epithelialization of oral mucosa show the impact of alendronate before dental extraction.

El objetivo fue evaluar la reparación ósea y gingival en ratas con osteopenia. Quince ratas wistar hembras fueron incluidas; en todas ellas se realizo ovarectomia y fue realizada la inducción de osteopenia; después de 45 días, los animales fueron sometidos a dos técnicas quirúrgicas 1) extracciones dentales del incisivo central superior sin preservación alveolar y 2) creación de un defecto craneano de 5 mm en la calota; 5 animales fueron incluidos como grupo control (G1) sin la aplicación de alendronato; en el grupo 2 (G2) se utilizó alendronato subcutáneo (0,5 mg/kg) una vez a la semana durante 3 semanas. En el grupo 3 (G3), después de la ovarectomia se realizó la exodoncia y el defecto en el cráneo y después de ello se inicio el protocolo con alendronato. En cada grupo, después de seis semanas se realizó la eutanasia con descripción histológica de los hallazgos. En el hueso formado en el defecto craneano de 5 mm se observó una adecuada progresión de reparación en los 3 modelos experimentales y no se observó cambios importantes en el modelo de reparación. Para el tejido gingival en el sitio de extracción, no se observaron diferencias entre el grupo G1 y G3. Por otra parte, el G2 presentó un tejido mas delgado con reducción del epitelio gingival; nuestros resultados demuestran que el alendronato no fue un obstáculo en la reparación ósea; deficiencias en la re epitelización de la mucosa oral muestran el impacto del alendronato después de la exodoncia.

Uso de bifosfonatos en pacientes con osteopenia / Biphosphonates in patients with osteopenia

La osteopenia, una disminución de la densidad mineral ósea de menor severidad que la osteoporosis, definida por valores de T-score entre -1,0 y -2,5 en la densitometría ósea , podría asociarse con un mayor riesgo de fracturas. Motivado por el pedido de una paciente con osteopenia que solicita a su médico algún medicamento que le ayude a disminuir su riesgo de fracturas, el autor se pregunta si los bifosfonatos podrían ser beneficiosos para las pacientes con este factor de riesgo. Luego de realizar una búsqueda bibliográfica y seleccionar la evidencia más reciente y de mejor calidad, se concluye que estos fármacos podrían ser útiles para prevenir fracturas en mujeres mayores de 65 años con elevado riesgo de fractura,independientemente del resultado de la densitometría. (AU)

Osteopenia, a minor decrease in bone mineral density, defined by T-score values between -1.0 and -2.5 in a bone densitometry, is associated with an increased risk of fractures. Moved by the request of a patient with osteopenia who asks her doctor for any medication that may help her reduce his risk of fractures, the author wonders if bisphosphonates could be beneficial for patients with this condition. After conducting a bibliographic search and selecting the most recent and best quality evidence, he concluded that these drugs could be useful to prevent fractures in women older than 65 years with ahigh risk of fracture, regardless of densitometry results. (AU)

Prevalencia de causas secundarias de baja masa ósea en una población de mujeres premenopáusicas / Prevalence of secondary causes in a population of premenopausal women with low bone mass

La osteoporosis es un trastorno común en las mujeres posmenopáusicas; sin embargo, también puede afectar a hombres y mujeres jóvenes premenopáusicas. El objetivo del presente trabajo fue evaluar la prevalencia de causas secundarias de baja masa ósea en un grupo de mujeres premenopáusicas que consultaron en una Institución especializada en Osteología. Material y métodos: se realizó un estudio retrospectivo, de corte transversal, descriptivo y observacional. Se analizaron las historias clínicas de 88 pacientes que consultaron por baja masa ósea durante un período de 19 meses, con la finalidad de encontrar posibles causas secundarias. A su vez, se definió como pacientes con diagnóstico de baja masa ósea idiopática aquellas en las cuales no se encontró ninguna causa secundaria de pérdida ósea. Resultados: de las 88 mujeres evaluadas, el 48,9% presentaba al menos una causa secundaria para baja masa ósea (amenorrea secundaria, hipercalciuria, tratamiento con glucorticoides, hipovitaminosis D y enfermedad celíaca) y el 51,1% fueron consideradas idiopáticas. Conclusiones: es esencial evaluar exhaustivamente a las mujeres premenopáusicas con baja masa ósea a fin de descartar posibles causas secundarias y tomar las medidas preventivas necesarias para mejorar esa condición. (AU)

Objective: osteoporosis is a common disorder in postmenopausal women, however it can also affect men and premenopausal young women. The purpose of this study was to evaluate the prevalence of secondary causes of low bone mass in premenopausal women that consulted physicians in an institution specialized in osteology for a period of 19 months. Material and methods: this is a retrospective, transversal, descriptive and observational study. The clinical history of 88 patients who consulted a physician due to low bone mass for a period of 19 months in an institution specialized in osteology. Were analyzed the patient's clinical history in order to find secondary causes. We define as suffering Low Bone Mass those patients who did not have secondary causes. Results: of the 88 women tested, 48,9% had one or more secondary causes or risks factors for low bone mass (secondary amenorrea, hypercalciuria, treatment with glucocorticoids, hypovitamiosis D and celiac disease) and 51,1% patients were considered idiopathic. Conclusions: we conclude that it is essential to exhaustively search for secondary causes of low bone mass in premenopausal women, due to the high prevalence of secondary osteoporosis in this population. (AU)

Reversal of uremic tumoral calcinosis by optimization of clinical treatment of bone and mineral metabolism disorder / Reversão da calcinose tumoral urêmica pela otimização do tratamento clínico da desordem do metabolismo ósseo e mineral

Abstract Tumoral calcinosis is an uncommon type of extraosseous calcification characterized by large rubbery or cystic masses containing calcium-phosphate deposits. The condition prevails in the periarticular tissue with preservation of osteoarticular structures. Elevated calcium-phosphorus products and severe secondary hyperparathyroidism are present in most patients with uremic tumoral calcionosis (UTC). Case report of an obese secondary to chronic glomerulonephritis, undergoing continuous ambulatory peritoneal dialysis (CAPD) reported the appearance of painless tumors in the medial surface of fifth finger and left arm. Tumoral calcinosis was confirmed by left biceps biopsy. Poor adherence to CAPD. The patient was transferred to the "tidal" modality of peritoneal dialysis and after was treated by hemodialysis, despite the persistence of severe hyperparathyroidism progressive reduction of UTC until near to its complete disappearance. Nowadays, one year after patient received deceased-donor kidney transplantation, he presents with an improvement in secondary hyperparathyroidism. UTC should be included in the elucidation of periarticular calcification of every patient on dialysis. Relevant laboratory findings such as secondary hyperparathyroidism and elevated calcium- phosphorus products in the presence of periarticular calcification should draw attention to the diagnosis of UTC.

Resumo A calcinose tumoral é um tipo raro de calcificação extraóssea caracterizada por grandes massas císticas e elásticas contendo depósitos de fosfato de cálcio. A condição é mais prevalente no tecido periarticular e preserva estruturas osteoarticulares. A elevação do produtos cálcio-fósforo e o hiperparatireoidismo secundário grave estão presentes na maioria dos pacientes com calcinose tumoral urêmica (UTC). O relato de caso em questão refere-se a um homem de 22 anos, branco, obeso, com doença renal crônica secundária à glomerulonefrite crônica, em diálise peritoneal ambulatorial contínua (CAPD), que apresentou aparecimento de tumores indolores na face medial do quinto quirodáctilio e braço esquerdo. A calcinose tumoral foi confirmada por biópsia do bíceps esquerdo. O paciente apresentava baixa adesão à CAPD. Foi transferido para a modalidade de diálise peritoneal e depois iniciou tratamento por hemodiálise. Apesar da persistência do hiperparatireoidismo grave, houve redução progressiva da UTC, com resolução próxima do seu desaparecimento completo. Há 1 ano o paciente foi submetido a transplante renal, doador falecido, e apresentou melhora do hiperparatiroidismo secundário. A UTC deve ser incluída na elucidação de calcificação periarticular de pacientes em diálise. Os achados laboratoriais relevantes, tais como hiperparatiroidismo secundário e elevação dos produtos cálcio-fósforo na presença de calcificação periarticular, devem chamar a atenção para o diagnóstico da UTC.

Osteoporosis: parte II: en enfermedades hepáticas y del tubo digestivo / Osteoporosis: part II: in liver and digestive tract diseases

The present review addresses liver and gastrointestinal diseases that are more frequently associated to osteopenia and osteoporosis. For each disease, we describe the prevalence and physiopathology of these bone metabolism conditions. The purpose is to create awareness of this scenario and prompt early analysis if these patients, and in other cases, to provide prophylaxis and treatment of these disorders.

En esta revisión se abordan las enfermedades hepáticas y del tubo digestivo que con mayor frecuencia se asocian a osteopenia y osteoporosis. En cada patología describimos la prevalencia y fisiopatología de estas afecciones del metabolismo óseo. El objetivo es dar a conocer esta realidad e inducir a que estos pacientes sean estudiados precozmente, en otros casos aplicar la profilaxis y tratar estos desórdenes.

Incidence of vertebral fractures in calcium and vitamin D-supplemented postmenopausal Brazilian women with osteopenia or osteoporosis: data from Arzoxifene Generations Trial

ABSTRACT Objective Vertebral fracture is the most common osteoporotic fracture, affecting quality of life and increasing mortality. Epidemiological data on incidence of vertebral fracture are scarce in Brazil and throughout Latin America. Our aim was to determine vertebral fracture incidence and risk factors in a female Brazilian population. Subjects and methods Postmenopausal women with low bone mass were studied from the Brazilian placebo group of Arzoxifene Generations Trial (n = 974), followed for up to 5 years. The primary endpoint was new vertebral fractures, detected by X-Ray. Experimental design defined two strata: A. Osteoporosis or previous vertebral fracture with osteopenia; B. Osteopenia without previous fracture. Previous fracture, T-score, ionized calcium, alkaline phosphatase, creatinine and glucose were analyzed at baseline. Crude and adjusted incidence rates of vertebral fractures were estimated and Poisson regression model was used. Results Incidence rate was 7.7 (95% CI of 5.4 to 10.9) per 1,000 person-years (PY), increasing as a function of age. Women with new vertebral fractures had higher prevalence of previous nonvertebral fracture after menopause, were older and had lower lumbar spine (LS) T-score. Fracture risk increased by 46% for each unit reduction in LS T-score. Variables correlated with new vertebral fracture were age (p = 0.034), LS T-score, stratum A (p = 0.001 for both) and previous nonvertebral fracture after menopause (p = 0.019). In the final model, LS T-score was the strongest predictor. Conclusions Incidence rate of vertebral fracture of 7.7 per 1,000 PY. Age and previous fractures were associated with new vertebral fracture, but LS T-score was the most important predictor.

Osteoporosis management in patient with renal function impairment / Manejo da osteoporose no paciente com função renal comprometida

Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, osteoporosis and chronic kidney disease (CKD) are common comorbid conditions in the elderly, and often coexist. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease. The ability of DXA (dual energy X-ray absorptiometry) to diagnose osteoporosis and to predict fractures in this population remains unclear. The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease. Furthermore, safety and effectiveness of osteoporosis drugs are not established in patients with CKD. Thus, risks and benefits of antiosteoporosis treatment must be considered individually.

O envelhecimento associa-se tanto ao declínio da qualidade óssea quanto da filtração glomerular. Consequentemente, osteoporose e doença renal crônica (DRC) são comorbidades frequentes em idosos, e muitas vezes coexistem. Anormalidades bioquímicas na homeostase do cálcio e do fósforo surgem precocemente na DRC, causando aumento do risco de fraturas e de complicações cardiovasculares desde fases precoces da doença. A capacidade da densitometria (DXA) em diagnosticar osteoporose e predizer fraturas nessa população é questionável. O manejo da doença é também controverso; cálcio e vitamina D são recomendados com cautela, devido ao risco de calcificações vasculares e de doença óssea adinâmica. Além disso, a segurança e a eficácia dos medicamentos para osteoporose ainda não estão estabelecidas em pacientes com DRC. Assim, riscos e benefícios do tratamento para osteoporose devem ser considerados individualmente nesses pacientes.

Premature graying of hair.

Premature graying is an important cause of low self-esteem, often interfering with socio-cultural adjustment. The onset and progression of graying or canities correlate very closely with chronological aging, and occur in varying degrees in all individuals eventually, regardless of gender or race. Premature canities may occur alone as an autosomal dominant condition or in association with various autoimmune or premature aging syndromes. It needs to be differentiated from various genetic hypomelanotic hair disorders. Reduction in melanogenically active melanocytes in the hair bulb of gray anagen hair follicles with resultant pigment loss is central to the pathogenesis of graying. Defective melanosomal transfers to cortical keratinocytes and melanin incontinence due to melanocyte degeneration are also believed to contribute to this. The white color of canities is an optical effect; the reflection of incident light masks the intrinsic pale yellow color of hair keratin. Full range of color from normal to white can be seen both along individual hair and from hair to hair, and admixture of pigmented and white hair is believed to give the appearance of gray. Graying of hair is usually progressive and permanent, but there are occasional reports of spontaneous repigmentation of gray hair. Studies evaluating the association of canities with osteopenia and cardiovascular disease have revealed mixed results. Despite the extensive molecular research being carried out to understand the pathogenesis of canities, there is paucity of effective evidence-based treatment options. Reports of repigmentation of previously white hair following certain inflammatory processes and use of drugs have suggested the possibility of cytokine-induced recruitment of outer sheath melanocytes to the hair bulb and rekindled the hope for finding an effective drug for treatment of premature canities. In the end, camouflage techniques using hair colorants are outlined.

Insuficiencia de vitamina D en pacientes adultos con baja masa ósea y osteoporosis en la Fundación Santa Fe de Bogotá 2008-2009 / Vitamin D insufficiency in adults patients with low bone mass and osteoporosis in the Fundación Santa Fe de Bogotá 2008-2009

La hipovitaminosis D se asocia con osteoporosis, enfermedades neuromusculares, autoinmunes y cáncer. La prevalencia oscila entre 11% y 70% en diferentes poblaciones estudiadas. Debido a que la osteoporosis es una enfermedad frecuente, determinamos la prevalencia de hipovitaminosis D asociada a desmineralización ósea en población atendida en la FSFB entre agosto de 2008 y julio de 2009; revisamos edad, género, T-Score, Z-score. Se consideró como rango normal de 25OHD entre 32 y 150 ng/dl. Hallamos 460 determinaciones de 25OHD, 105 sujetos con osteodensitometría DXA, 80% mujeres. Edad promedio 66 años (DE ± 12,5; rango 39 a 91); para mujeres fue 67,1 años (DE ± 12,2; rango 39 a 91), para hombres fue 61 años (DE ± 10,7; rango 42 a 82). Los niveles de 25OHD promedio fueron de 31 ng/ml (DE ± 17,6; rango 8,2 a 110); para mujeres 30,5 ng/ml (DE ± 16,1; rango 10,6 a 96 ng/ml), para hombres 33,5 ng/ml (DE ± 23,4; rango 8,2 a 110 ng/ml). El 69,5% de casos presentaron algún nivel de insuficiencia de vitamina D, 45,7% insuficiencia leve y 23,8% insuficiencia moderada; no hay casos con insuficiencia severa. No hubo diferencias significativas entre concentraciones de 25OHD entre hombres y mujeres; o edad. La osteoporosis se correlaciona con niveles de 25OHD inferiores a 28 ng/ml (P= 0,046), pero no hay correlación entre niveles bajos de 25OHD y osteopenia. La hipovitaminosis D es muy prevalente en pacientes con osteoporosis y baja masa ósea y debe evaluarse en el contexto de osteoporosis.

Densidade mineral óssea sistêmica vs situação clínica periodontal: estudo transversal em mulheres na pós-menopausa / Systemic bone mineral density versus clinical periodontal condition: cross-sectional study in postmenopausal women

OBJETIVO: Analisar a densidade mineral óssea sistêmica (DMO) e a situação periodontal em mulheres na pós-menopausa, visando compreender o papel da osteoporose como um fator de risco à doença periodontal. MÉTODOS: A amostra da pesquisa foi constituída por 47 mulheres na pós-menopausa, que foram divididas em três grupos: 14 com osso normal (G1), 17 no grupo com osteopenia (G2) e 16 pacientes com osteoporose (G3), através da avaliação da densidade mineral óssea (DMO), aferida pela absormetria de dupla emissão com raios-X na área lombar (L1-L4). A condição periodontal foi avaliada pelo índice gengival (IG), índice da placa (IP) e o nível de inserção clínica (NIC). Os resultados tabulados foram analisados e submetidos ao tratamento estatístico, através do teste ANOVA a um critério (α=0,05) e o teste de correlação de Pearson (α=0,01). RESULTADOS: Verificou-se não haver diferenças significativas na situação periodontal em mulheres na pós-menopausa, através das variáveis IG, IP e NIC. Observou-se correlação significativa entre os parâmetros periodontais IG, IP e NIC entre si (p<0,001), contudo não foi detectada correlação significativa entre os parâmetros periodontais (IG, IP, NIC) e a condição sistêmica do osso das mulheres na pós-menopausa, avaliada através da DMO (p>0,01). CONCLUSÃO: A situação periodontal em mulheres na pós-menopausa não depende da massa óssea sistêmica, não havendo correlação significativa entre DMO e os parâmetros periodontais, sendo necessárias pesquisas longitudinais para considerar a osteoporose como um fator de risco à doença periodontal.

OBJECITVE: To assess the systemic bone mineral density (BMD) and the periodontal situation in postmenopausal women, to understand the possible role of osteoporosis as a risk factor for periodontal disease. METHODS: The sample was comprised of 47 postmenopausal women, divided into 3 groups: 14 patients with normal bones (G1), 17 with osteopenia (G2) and 16 patients with osteoporosis (G3). Data was obtained using bone mineral density (BMD), obtained by dual energy x-ray absorptiometry (DXA) in the lumbar area (L1-L4). Periodontal condition was evaluated by Gingival Index (GI), Plaque Index (PI) and Clinical Attachment Level (CAL). Results were analyzed and submitted to statistical treatment, through the One Way ANOVA: (α=0.05) test and the Pearson's Correlation test (α=0.01). RESULTS: GI, PI and CAL variables did not disclose a significant difference in the periodontal situation of postmenopausal women A significant correlation between periodontal parameters GI, PI and CAL (p<0,001) was observed, however no significant correlation was detected between periodontal parameters (GI, PI and CAL) and systemic bone condition of postmenopausal women, evaluated by BMD (p>0.01). CONCLUSION: The periodontal situation of postmenopausal women does not depend on the systemic bone mass and there is no significant correlation between BMD and periodontal parameters. However, further longitudinal surveys are required to understand osteoporosis as a risk factor of periodontal disease.

Deformidades vertebrais em grupo selecionado de mulheres com osteopenia e osteoporose em São Luís do Maranhão / Vertebral deformities in a selected group of women with osteopeny and osteoporosis in São Luis, Maranhão

Objetivos: Avaliar a presença de defomlidades vertebrais, na coluna lombar, em mulheres com osteopenia/osteo­porose, a partir dos 40 anos, em São Luís, Maranhão. Material e Método: Estudo prospectivo, transversal, mulheres climatéricas, demanda espontânea, densitometria óssea recente (últimos 12 meses), apresentando osteopenia/osteoporose, realizado no Centro de Densitometria Óssea do Maranhão, São Luís, de março a dezembro, 2006. Foi aplicado questionário, e as pacientes submetidas à radiografia de coluna lombo-sacra no Centro de Diagnóstico Médico do Maranhão. Resultados: A densitometria óssea revelou nas 222 mulheres, osteopenia em 109 e osteoporose em 113. Maior frequência de osteoporose em mulheres com mais de três gestações e partos, pós-menopáusicas, diabéticas, não obesas, sedentárias, usuárias de bebida alcoólica, não usuárias de leite e derivados. Deformidades vertebrais à radiografia de coluna lombo-sacra, associadas à osteoporose: redução de espaços discais 52%, fraturas vertebrais 12%, achatamento de corpos vertebrais 8%, colapsos vertebrais 4%. Maior frequência de deformidades vertebrais anteriores à osteoporose: osteofitos 75%, escoliose 69%, artrose 35%. Conclusões: Cor branca, baixa escolaridade, aposentadas, faixa etária de 40 a 59 anos de idade, predominando osteopenia, e acima de 60 anos, osteoporose. Alendronato de sódio por mais de 12 meses demonstrou efeito protetor contra osteoporose. Maior frequência de deformidades vertebrais anteriores e associadas à osteoporose. Principais complicações da osteoporose na coluna lombar: fraturas e colapsos vertebrais.

Bone mineral density of Brazilian girls with juvenile dermatomyositis

We measured bone mineral density (BMD) in girls with juvenile dermatomyositis (JDM) considering multiple factors in order to determine if it could be used as a predictor of reduction in bone mass. A cross-sectional study of lumbar spine BMD (L2-L4) was conducted on 10 girls aged 7-16 years with JDM. A group of 20 age-matched healthy girls was used as control. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in all patients and controls. Duration of disease and mean daily and cumulative steroid doses were calculated for all patients on the basis of their medical charts. JDM activity was determined on the basis of the presence of muscle weakness, cutaneous vasculitis and/or elevation of serum concentration of one or more skeletal muscle enzymes. Seven patients demonstrated osteopenia or osteoporosis. Lumbar BMD was significantly lower in the JDM patients than the age-matched healthy control girls (0.712 vs 0.878, respectively; Student t-test, P = 0.041). No significant correlation between BMD and age, height, Tanner stage, disease duration, corticosteroid use, or disease activity was observed in JDM girls, but a correlation was observed between BMD and weight (Pearson's correlation coefficient, r = 0.802). Patients with JDM may be at risk for a significant reduction in BMD that might contribute to further skeletal fragility. Our results suggest that reduced bone mass in JDM may be related to other intrinsic mechanisms in addition to steroid treatment and some aspects of the disease itself may contribute to this condition.

Tratamiento de la Osteoporosis

La osteoporosis es el síndrome más frecuente dentro de la enfermedad metabólica ósea. Su importancia aumenta de forma paralela al aumento de la esperanza de vida de la población y al envejecimieto de ésta; su complicación, la fractura, puede producir un enmpeoramiento severo de la calidad de vida, siendo la de cadera una causa importante de mortalidad en los ancianos. Al diagnosticar la existencia de la osteoporosis es importante caracterizar su etiología y grado de recambio óseo para iniciar el tratamiento, el cual puede dividirse en profiláctico y terapéutico sidno su objetivo final la prevención de complicaciones.Son múltiples los tratamiento propuestos para este proceso, apareciendo cada año nuevos fármacos. Los tratamientos tienden a mantener al paciente con niveles de densidad mineral ósea por encima del riesgo de fracturas, pero debido a que la pérdida de calcio es un fenómeno fisiológico, una vez se suspende el tratamiento, este proceso de pérdida se inicia de nuevo. La elección del fármaco será individualizada, deberá basarse en el tipo de osteoporosis, su remodelado óseo y la tolerancia y respuesta del paciente al fármaco

Analise histomorfometrica do tecido osseo do paciente diabetico nao insulino-dependente (DMNID) / Histomorphometric analysis of the bone tissue in patients with non insuline dependent diabetes

Os efeitos a longo a prazo do diabetes mellitus sobre o metabolismo mineral e a integridade ossea ainda nao foram completamente elucidados.Alguns estudos demonstraram que pacientes portadores de diabetes mellitus insulino-dependentes (DMNID) apresentaram reducao da massa ossea. Entretanto, existem controversias quanto aos efeitos do diabetes mellitus nao insulino-dependentes (DMNID) sobre a massa ossea. A analise quantitativa do tecido osseo da crista iliaca foi realizada em 26 pacientes (13 homens e 13 mulheres) portadores de DMNID com funcao renal normal (creatinina serica de 1.00+-0.04 mg/dl)...

Osteopenia en cirrosis biliar primaria: estudio en 20 pacientes / Osteopenia in primary biliary cirrhosis: study in 20 patients

We studied 20 female patients, aged 51 ñ 13.6 years old, with the diagnosis of Primary Biliary Cirrhosis (PBC) to assess osteopenia, main involved sites and its relation to menopause, some parameters of mineral metabolism and the degree of histological liver involvement. The diagnosis of PBC was based in histological, clinical and laboratory features. Bone densitometry was measured with dual-photon densitometer and compared with values of a normal female population from the laboratory. When compared to controls, studied patients had a significantly lower lumbar spine bonedensity and total bone mineral content and a non significantly lower density in femoral neck and total body. Serum calcium, phosphorus, magnesium, PTH and urinary calcium/creatinine ratio were within normal limits. Lumbar spine density was no significantly lower in patients with more severe liver histological involvement and in postmenopausal women. No correlation was found between the duration of postmenopausal period and the degree of osteopenia. It is concluded that patients with PBC have a clear lumbar spine osteopenia and a lower total mineral content and that these parameters worsen in a non significant fashion in subjects along with liver histological involvement and with the length of post menopausal period

Prevalence and magnitude of osteopenia in patients with prolactinoma

1. The association between hypogonadism and osteoporosis has been reported. We conducted a study to establish the prevalence and magnitude of osteopenia in patients with prolactinoma and the relationship of bone loss with the duration of hypogonadism. 2. We measured the bone mineral density (BMD) of spine and femur (a site that has not been analyzed earlier) in 35 patients with prolactinoma using a dual-energy X-ray absorptiometer. The patients were classified as normal BMD and low BMD (osteopenics). 3. Seventeen patients (48 per cent ) showed osteopenia. The mean bone loss in the different regions was: spine, 13 per cent ; femoral neck, 15 per cent ; trochanter, 11 per cent ; Ward's, 22 per cent . This difference was only significant when the spine and Ward's region were compared. The duration of hypogonadism was significantly greater in the low-BMD group (11.3 vs 4.9 years) when compared to the normal BMD group. There was a positive relationship between the duration of hypogonadism and magnitude of bone loss in both spine and femur (P = 0.04; r = 0.6). 4. A high prevalence of osteopenia in both spine and femur was found in patients with prolactinoma, and was highly associated with the duration of hypogonadism. Early treatment of this condition seems important to prevent bone loss